Sunday, September 8, 2013

The transport mechanism of monosaccharides across the intestinal mucosal cells.


o   Monosaccharides are formed by single saccharide molecules.
o   We normally talk about glucose, fructose & galactose as monosaccharides. There are so many except these three.
o   When we talk about starches, they are digested to various types of monosaccharides, disaccharides by gut enzymes secreted from various organs like pancreas.
o   There are same enzymes which digest disaccharides to monosaccharides. They are placed on brush border of the mucosal cells. Isomoltase, Moltase, Sucrose.
o   After the digestion final product is monosaccharides & they are transported across the intestinal mucosal cells to the portal system by various transport mechanisms.


How G protein help in signal transmission in to the cell from an incoming ligand & outline the steps.


  • Ligand bind G protein coupled receptor which has α ,β & γ subunits.
  • After binding, GTP in α dissociates from β & γ( all 3 subunits can produce physiological effects)
  • Causes production of a 2nd messenger eg:-cAMP via activation of adenylyl cyclase.
  • cAMP produce activated protein kinase A( pKA)  à  pKA phosphorylate certain molecules & activate /inhibit  à brings about the physiological action
  • When work is done , intrinsic GTPase activity of GTP-α converts GTP to GDP   à α ,β & γ subunits reassociates  à action terminates.

Monday, April 15, 2013

Management of Postpartum Collapse

COLLAPSE

Before delivery
 
After delivery
After 3rd stage
Rupture uterus
PPH – During 3rd stage
Ruptured uterus
Amniotic fluid embolism
 
Uterine inversion
 
RUPTURED UTERUS
History
  • Past caesarean section
  • Grand multigravida
  • Multigravida given oxytocin during labour
  • Almost never in primigravida - except following manipulations or previous uterine scar e.g. myomectomy

Management of Postpartum Collapse - AMNIOTIC FLUID EMBOLISM


Presentation
  • Extremely sudden severe shock with severe dyspnoea, cyanosis Pulmonary oedema
  • Blood stained frothy sputum
  • Convulsions may occur  
Onset
  • Usually immediately after membranes rupture however it can occur even with intact membranes occurs during strong uterine contractions
  • Usually fatal 

Saturday, April 13, 2013

Management of Postpartum Collapse - CONVULSIONS

Convulsions may be due to eclampsia, epilepsy, malaria, head injury, cerebral abscess, meningitis, encephalitis, etc.

Whatever the cause, initial steps are the same.
  • Stop the fits
  • Maintain airway
  • Prevent aspiration
  • Prevent injuries
Immediate care :
  • Position the patient - head low, turn to a side
  • airway - plastic or metal
  • Suck the mouth and pharynx
  • Place cushions around the patient or tie the limbs loosely with soft cloth  
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